HomeMy WebLinkAbout2023 Sign off Transmittal - 3 Season Porch into a Family Room TOWN OF 441. HEALTH DEPARTMENT
•
� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant.
Building Site Location: (.lt C �1 l I111 .I
Proposed Improvement: Tl/rrf ecl ( S'GLO i'1 �Or(`1 f(� rode-i I1 Oc.2)-
Applicant: -27, le cook__ Tel. No.. 7
Address: / U/i c 1€ -7 br\1 /7 /(1.-eiri ) Date Fi led: 1 07-1y`��-.
**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: Pc / ' COO<<
Owner Address: / )i�(/�' 1 �� /� S //7 ltyM'd 'o
£ Owner Tel. No.: 77 ) r/ J
ak
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e.. Requirements
For Septage Disposal and other Public Health Activities.
Please submit three (3) copies of plans, to include:
,� (1.) Site Plan showing existing buildings, water line location,
and septic system location;
DEC 14 2022 (2.) Floor plan labeling ALL rooms within building
HE (all existing and proposed) —
Note: Floor plans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
•
REVIEWED BY: / DATE: /0 0 c/a. a
PLEASE NOTE
COMMENTS/CONDITIONS: